- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.13 / $1,181.00 / $7,439.00
| Facility | | $554.13 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.13 / $583.77 / $1,037.19
| Professional | | $554.13 | $583.77 | $1,037.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.61 / $1,457.61 / $1,478.88
| Facility | | $1,457.61 | $1,457.61 | $1,478.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.91 / $833.38 / $1,501.35
| Professional | | $411.91 | $833.38 | $1,501.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,587.44
| Facility | | $606.10 | $606.10 | $1,587.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.64 / $773.33 / $1,273.51
| Professional | | $556.64 | $773.33 | $1,273.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.13 / $690.23 / $993.67
| Facility | | $554.13 | $690.23 | $993.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $634.00 / $739.00
| Professional | | $507.00 | $634.00 | $739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $753.90 / $1,351.50
| Professional | | $4.00 | $753.90 | $1,351.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.00 / $3,456.00 / $5,919.00
| Facility | | $1,064.00 | $3,456.00 | $5,919.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.90 / $654.00 / $1,494.79
| Professional | | $465.90 | $654.00 | $1,494.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,671.45 / $5,246.20 / $16,394.00
| Facility | | $2,671.45 | $5,246.20 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,480.39 / $4,480.39 / $4,923.08
| Professional | | $4,480.39 | $4,480.39 | $4,923.08 |